There is increasing evidence for the effect of obesity on knee osteoarthritis (OA), although the association between obesity, particularly body composition, and knee osteoarthritis, using magnetic resonance imaging (MRI) to examine knee structure, has not been examined. We systematically evaluated the evidence for the relationship between obesity and knee cartilage assessed by MRI. We performed an electronic search of MEDLINE and EMBASE up to December 2012. Included studies investigated the association between obesity and the development and/or progression of knee cartilage changes using MRI. The studies were ranked according to their methodological score and best-evidence synthesis was performed to summarize the results Twenty-two studies were identified for inclusion, of which 7 were cross-sectional, 13 were longitudinal and 2 had both cross-sectional and longitudinal components. Seven cross-sectional and eight longitudinal studies were of high quality. Best-evidence synthesis showed consistent, yet limited evidence for a detrimental effect of body mass index (BMI) and fat mass on knee cartilage. This review identified a consistent detrimental effect of obesity, particularly related to elevated BMI and fat mass on cartilage defects. The strength of evidence was limited by the paucity of high-quality cohort studies examining this question. By further examining the mechanisms for these different effects, new strategies can be developed to prevent and treat knee OA.

Whilst arthroscopic surgery for the treatment of meniscal tears is the most commonly performed orthopaedic surgery, meniscal tears at the knee are frequently identified on magnetic resonance imaging in adults with and without knee pain. The evidence for arthroscopic treatment of meniscal tears is controversial and lacks a supporting evidence base; it may be no more efficacious than conservative therapies. Surgical approaches to the treatment of meniscal pathology can be broadly categorised into those in which partial menisectomy or repair are performed. This review highlights that the major factor determining the choice of operative approach is age: meniscal repair is performed exclusively on younger populations, while older populations are subject to partial menisectomy procedures. This is probably because the meniscus is less amenable to repair in the older population where other degenerative changes co-exist. In middle-aged to older adults, arthroscopic partial menisectomy (APM) may treat the meniscus tear, but does not address the degenerative whole organ disease of knee osteoarthritis. Thus far, there is no convincing evidence that operative approaches are superior to conservative measures as the first-line treatment of older people with knee pain and meniscal tears. However, in two randomised controlled trials (RCTs) approximately one-third of subjects in the exercise groups had persisting knee pain with some evidence of improvement following APM, although the characteristics of this subgroup are unclear. From the available data, a first-line trial of conservative therapy, which includes weight loss, is recommended for the treatment of degenerative meniscal tears in older adults. The exception to this may be when mechanical symptoms, such as knee locking, predominate. Although requiring corroboration by RCTs, there is accumulating evidence from cohort studies and case series that meniscal repair rather than APM may improve function and reduce the long-term risk of knee osteoarthritis in young adults. There is no clear evidence from RCTs that one surgical method of meniscal repair is superior to another.

Fibromyalgia presents with symptoms of widespread pain, fatigue, sleeping and cognitive disturbances as well as other somatic symptoms. It often overlaps with other conditions termed 'central sensitivity syndromes', such as irritable bowel syndrome, chronic fatigue syndrome and temporomandibular disorder. Central sensitisation, mediated by amplified processing in the central nervous system, has been identified as the key pathogenic mechanism in these disorders. The term 'central sensitivity' can be used to describe collectively the clinical presentation of these disorders. Fibromyalgia is highly prevalent in most rheumatic diseases as well as non-rheumatic chronic diseases and if unrecognised results in high morbidity. It is diagnosed clinically after excluding important differential diagnoses. Diagnostic criteria have been developed as tools to help identify and diagnose fibromyalgia. Such tools can fulfil an important need when managing patients with rheumatic disease and other chronic diseases as a way to identify fibromyalgia and improve patient outcomes. Treatment involves an integrated approach including education, exercise, stress reduction and pharmacological therapies targeting the central nervous system. This approach is suitable for all presentations of central sensitivity and some central sensitivity syndromes have additional treatment options specific to the clinical presentation.

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